Real-world resource use and costs of adjuvant treatment for stage III colon cancer

Gils, C.W.M. van; Groot, Saskia de; Tan, Siok Swan; Redekop, William K.; Koopman, Miriam; Punt, Cornelis J.A.; Groot, C.A. Uyl-de

doi:10.1111/ecc.12154

Cited by 9 publications

(6 citation statements)

References 38 publications

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“…18 3.6 Oral vs. intravenous AC Of the 9 full economic evaluations comparing capecitabine to 5FU in stage III, 6 (67%) concluded capecitabine dominates 5-FU (being less costly and more effective) and 1 (11%) reported costeffectiveness (more costly but more effective). [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Of the two remaining studies, Soni et al utilised data from a retrospective cohort study, noting patients receiving capecitabine were older (mean age: 73 vs. 67 years) and less t (ECOG 2-4: 14.6% vs. 6.3%). 30 Accordingly, these patients were less likely to receive full intensity of treatment with the authors concluding that capecitabine would be cost-effective if treatment intensity approached 100%.…”

Section: Ac Vs No Acmentioning

confidence: 99%

“…15 Amongst stage III studies, 7 of 8 (88%) full economic evaluations determined that FOLFOX was cost-effective compared to 5-FU alone. 22,26,30,32,34,[39][40][41][42][43] The remaining study modelled strategies that included different treatments for metastatic recurrence, limiting the assessment of AC alone. 32 Additionally, Pandor et al concluded that FOLFOX dominates capecitabine in stage III.…”

Section: Oxaliplatin-based Acmentioning

confidence: 99%

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Health economic evidence for adjuvant chemotherapy in stage II and III colorectal cancer: a systematic review

Gibbs

Tie

et al. 2022

Preprint

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Objective: The aims of this study was to appraise the health economic evidence for adjuvant chemotherapy (AC) strategies in stage II and III colorectal cancer (CRC) and to identify gaps in the available evidence that might inform further research.Method : A systematic review of published economic evaluations was undertaken. Four databases were searched and full-text publications in English were screened for inclusion. A narrative synthesis was performed to summarise the evidence.Results: Thirty-eight studies were identified and stratified by cancer stage and AC strategy. The majority (89%) were full economic evaluations considering both health outcomes, usually measured as quality-adjusted life years (QALYs), and costs. AC was found to be cost-effective compared to no AC for both stage II and III CRC. Oral and oxaliplatin-based AC was cost-effective for stage III. Three months of CAPOX was cost-effective compared to 6-month in high-risk stage II and stage III CRC. Preliminary evidence suggests that biomarker approaches to AC selection in stage II can reduce costs and improve health outcomes. Notably, assessment of QALYs were predominantly reliant on a small number of non-contemporary health-utility studies. Only 32% of studies considered societal costs such as travel and time off work. Conclusions: Published economic evaluations consistently supported the use of AC in stage II and III colorectal cancer. Biomarker-driven approaches to patient selection have great potential to be cost-effective, but more robust clinical and economic evidence is warranted. Patient surveys embedded into clinical trials may address critical knowledge gaps regarding accurate assessment of QALYs and societal costs in the modern era.

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Section: Ac Vs No Acmentioning

confidence: 99%

Section: Oxaliplatin-based Acmentioning

confidence: 99%

Health economic evidence for adjuvant chemotherapy in stage II and III colorectal cancer: a systematic review

Gibbs

Tie

et al. 2022

Preprint

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“…It should be noted that, in contrast to intravenously administered therapy, orally administered drugs come with their own challenges, such as patient adherence and increased need to monitor adherence. [37][38][39] The widespread success and adoption of capecitabine may underscore the importance of further public investment in drugs which may not provide additional lines of therapy, but which may keep these important drugs widely accessible in an environment where healthcare resources grow ever more constrained.…”

Section: Study Implicationsmentioning

confidence: 99%

Impact of new cancer therapies on outpatient treatment delivery for colorectal cancer: A population‐based study

Chen

Speers

Cheung

et al. 2021

Health Planning & Management

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We investigated the impact of new systemic therapies approved in Canada for colorectal cancer on the frequency, intensity and duration of oncology clinic and infusion visits over five treatment phases from diagnosis (P1, P3) to treatment (P2, P4) of primary and metastatic disease, respectively, and during the last 6 months of life (P5). In total, 15,157 adult patients with newly diagnosed colorectal cancer and referred between 2000 and 2012 to any cancer clinic in British Columbia, Canada, were included. Frequency, intensity and duration of medical oncology clinic visits (CVs), oncology infusions (OIs) and oncology prescriptions (OPs) were measured by treatment phase. Mean, total and adjusted total duration for CVs increased for P1-5. CVs increased in P1-5, and in P1-4 when adjusted by treatment length. Adjusted and unadjusted OIs decreased in P1 coinciding with the introduction of an oral treatment option, but increased in P2-5. Mean OI duration increased in P1-5, while total and adjusted total decreased in P1 and increased in P2-5.OPs increased in P2-4, but were unchanged in P1 and P5.Multi-fold increases in resources and time required per patient were also observed, which have significant implications for demand projections in cancer care planning and

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“…treatment with 5-FU typically requires the use of indwelling catheters, pumps for continuous infusion and several hospital visits by the patient or home visits by medical personnel, capecitabine is self-administered orally. Thus, the use of 5-FU would be expected to result in increased health care service utilization associated with treatment administration compared with capecitabine [ 5 – 12 ], as well as the costs to the patient for traveling to, and remaining at the hospital for treatment [ 6 , 10 , 11 , 13 ]. Given these differences in the mode of administration and potential accessibility of treatment, several studies have noted a preference by patients for capecitabine over 5-FU on the basis of convenience [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Impacting Treatment Choice in the First-Line Treatment of Colorectal Cancer

et al. 2016

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IntroductionTo investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC).MethodsPatients treated with 5-FU or capecitabine for CRC between January 1, 2011 and December 31, 2013 in a teaching hospital in the Sydney metropolitan area, Australia were identified using the hospital’s database MOSAIQ®. The electronic medical record of each patient was manually reviewed to extract factors potentially affecting treatment choice. Logistic regression was used to assess which patient and/or treatment factors could explain the choice between 5-FU or capecitabine. Where it was available in the medical correspondence, the explicit reason for the choice made was extracted.Results170 CRC patients were included; 119 on 5-FU, and 51 on capecitabine. The odds of receiving capecitabine as a first-line treatment were positively associated with giving patients a choice in the decision (OR = 17.51, 95% CI: 5.37–57.08). Qualitative data suggest treatment choices were motivated by convenience (oral administration) and tolerability. Time from diagnosis to treatment commencement (OR = 1.02 per month, 95% CI 1.00–1.04) was also found to be positively associated with the choice of capecitabine. The odds of being treated with capecitabine were lower for patients who lived further from the treating hospital (OR = 0.22, 95% CI 0.05–0.94).ConclusionThis study suggests that patient choice, favoring oral capecitabine over i.v. 5-FU, was a key factor influencing first-line treatment for CRC in this cohort. To respect their autonomy, patients should be involved in the clinical decision making process.Electronic supplementary materialThe online version of this article (doi:10.1007/s40487-016-0020-4) contains supplementary material, which is available to authorized users.

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Real-world resource use and costs of adjuvant treatment for stage III colon cancer

Cited by 9 publications

References 38 publications

Health economic evidence for adjuvant chemotherapy in stage II and III colorectal cancer: a systematic review

Health economic evidence for adjuvant chemotherapy in stage II and III colorectal cancer: a systematic review

Impact of new cancer therapies on outpatient treatment delivery for colorectal cancer: A population‐based study

Factors Impacting Treatment Choice in the First-Line Treatment of Colorectal Cancer

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